Long-term clinical experience with helical tomotherapy for head and neck cancer

Objective The objective of this study is to review a long-term single-institutional experience with helical tomotherapy (HT) for the radiotherapeutic management of head and neck cancer. Methods From February 2006 to January 2013, a total of 301 consecutive patients with squamous cell carcinoma of the head and neck were treated with HT to a median dose of 66 Gy (range, 60 to 72 Gy). One hundred and seventy patients (56 %) underwent definitive HTand 131 patients (44 %) were treated post-operatively after surgery. There was no significant imbalance in patient or disease characteristics among patients treated with or without surgery (p>0.05). Megavoltage computed tomography (MVCT) scans were obtained for patient alignment prior to each delivered fraction. Concurrent chemotherapy was administered to 133 patients (43 %). Results The 3-year estimates of overall survival, local-regional control, and disease-free survival were 76, 82, and 69 %, respectively. No difference existed with any of these endpoints among patients treated by definitive surgery versus radiation (p>0.05). The incidence of grade 3+ acute toxicity was 30 %, with the most common related to skin erythema/desquamation, oral mucositis, esophagitis, dysguesia, and xerostomia. Post-HT esophageal stricture requiring dilatation was diagnosed in 12 %. Thirty (10 %) and 16 patients (5 %) were gastrostomy tubedependent at 6 months and 1 year after HT, respectively. Conclusion HTachieves clinical outcomes consistent with other IMRT methods and is an effective means of treatment for head neck cancer either as primary or post-operative therapy.